Office of Compliance Programs
Federal False Claims Act, 31 USC § 3279
The False Claims Act is a federal statute that covers fraud involving any federally funded contract or program, including the Medicaid and Medicare programs. This act is commonly known as the “Lincoln Law” because it was first enacted to counter fraudulent activities involving military procurement during the Civil War. The act establishes liability for any person who knowingly presents or causes to be presented a false or fraudulent claim to the U.S. government for payment
The term “knowingly” is defined to mean that a person, with respect to information:
· Has actual knowledge of falsity of information in the claim;
· Acts in deliberate ignorance of the truth or falsity of the information in a claim; or
· Acts in reckless disregard of the truth or falsity of the information in a claim.
For purposes of the False Claims Act, a “claim” includes any request or demand for money that is submitted to the U.S. government or its contractors.
Health care providers and suppliers who violate the False Claims Act can be subject to the following:
· Civil monetary penalties (CMP) ranging from $5,500 to $11,000 for each false claim submitted.
· In addition to the above (CMP), can be required to pay three times the amount of damages sustained by the U.S. government.
· If convicted of a False Claims Act violation, the OIG may seek to exclude the provider or supplier from participation in federal health care programs.
What is a False Claims Violation?
Any conduct that leads to the submission of fraudulent claims to the government such as knowingly making false statements, falsifying records, double-billing for items or services, submitting bills or services never performed or items never furnished, or otherwise causing a false claim to be submitted.
Qui Tam “Whistleblower” Provisions
Encourages individuals to come forward and report misconduct involving false claims, the False Claims Act includes a “qui tam” or whistleblower provision. It allows any person with actual knowledge of allegedly false claims to the government Such persons are know as a “relators.” By way of example, the U.S. Department of Justice reports that the federal government obtained more than $1.4 billion in settlements and judgments for fraud committed against the government in 2004-2005.
Qui Tam Procedure
The relator must file his or her lawsuit on behalf of the government in a federal district court. The lawsuit will be file “under seal,” meaning that the lawsuit is kept confidential while the government reviews and investigates the allegations contained in the lawsuit and decides how to proceed.
Rights of Parties to Qui Tam Actions
If the government determines that the lawsuit has merit and decides to intervene, the prosecution of the lawsuit will be directed by the U.S. Department of Justice. If the government decides not to intervene, the whistleblower can continue with the lawsuit on his or her own.
Award to Qui Tam Whistleblowers
If the lawsuit is successful, and provided certain legal requirements are met, the qui tam relator may receive an award ranging from 15 to 30 percent of the amount recovered. The whistleblower may also be entitled to reasonable expenses including attorney’s fees and costs for bringing the lawsuit.
In addition to a financial award, the False Claims Act entitles whistleblowers to additional relief, including employment reinstatement, back pay, and any other compensation arising from retaliatory conduct against a whistleblower for filing an action under the False Claims Act or committing other lawful acts, such as investigating a false claim or providing testimony for, or assistance in, a False Claim Act action.
Louisiana State Law
Under Louisiana state law, the definition of a false or fraudulent claim is slightly broader, At LSA R.S. 46.437.--, “8) "False or fraudulent claim" means a claim which the health care provider or his billing agent submits knowing the claim to be false, fictitious, untrue, or misleading in regard to any material information. “
Just as with the
federal whistleblower statute, under Louisiana state law, “a
private person (“Qui
Tam plaintiff) may institute a civil action (“Qui Tam Action”)
in the courts of this state on behalf of the medical assistance
programs and himself to seek recovery
No employee shall be discharged,
demoted, suspended, threatened, harassed, or discriminated
against in any manner in the terms and conditions of his
employment because of any lawful act engaged in by the employee
or on behalf of the employee in furtherance of any action taken
pursuant to this Part in regard to a health care provider or
other person from whom recovery is or could be sought. Such an
employee may seek any and all relief for his injury to which he
is entitled under state or federal law.
Rewards for fraud and abuse
Louisiana State False Claims Penalties
· Payment of actual damages
· In addition to actual damages, a civil fine not to exceed 10,000 dollars per violation; OR
· A civil fine not to exceed three times the value of the illegal remuneration, whichever is GREATER.
· Payment of interest on the mandatory civil fine imposed